Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 118-135).

This study utilized data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) at two different time points, seven years apart, to examine the relationship between physical illness and depressive symptoms in elderly Mexican Americans. The two physical illnesses studied are coronary artery disease and type II diabetes due to their high prevalence among Mexican Americans. The relationship between physical illness and depressive symptoms is examined longitudinally and prospectively, in both directions. In addition, the relationship between depressive symptoms and three behavioral health risk factors: alcohol use, cigarette smoking, and physical inactivity, at baseline is examined. The roles of gender, acculturation, nativity, and locus of control are examined as moderators of the key relationships studied. Additionally, self-rated health at baseline is examined as a predictor of physical illness and mortality at follow-up. / text

Although blood viscosity is an important component in determining vascular function, it is often assumed constant. Emerging evidence linking individual differences in viscosity to cardiovascular disease casts doubt on this assumption. The purpose of this study was to determine the contribution of whole blood viscosity to key measures of vascular function. To address this aim as comprehensively as possible, first, whole blood viscosity was compared with traditional risk factors for cardiovascular disease. Then flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (cfPWV), and carotid artery compliance were calculated either with or without blood viscosity taken into account. Lastly, we tested whether the removal of blood viscosity could influence well-established associations between age and vascular function. Blood viscosity and vascular function were measured in 97 adults ranging in age from 18-63 years. No significant differences were observed between whole blood viscosity and traditional risk factors for cardiovascular disease. Whole blood viscosity was not significantly correlated with FMD, cfPWV, and carotid compliance. As expected, age was positively correlated with cfPWV (r=0.65, p<0.001) and negatively correlated with FMD (r=-0.21, p<0.05) and carotid compliance (r=-0.45, p<0.01). Even after controlling for viscosity, these relationships remained statistically significant (cfPWV r=0.65, p<0.001; FMD r=-0.24, p<0.05; carotid compliance r=-0.44, p<0.05). These results indicate that whole blood viscosity does not appear to significantly impact measures of vascular function and that the rationale for including whole blood viscosity in the calculation of vascular function remains weak. / text

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Aterosklerozė, kaip arterijas pažeidžianti liga, žinoma jau daugelį metų. Periferinių arterijų okliuzinės ligos (PAOL) simptomus jaučia apie 27 milijonai žmonių Šiaurės Amerikoje ir Europoje. Nežiūrint gerėjančios PAOL diagnostikos, chirurginio, endovaskulinio ir medikamentinio gydymo, jos paplitimas toliau didėja. Ši liga ypač neigiamai veikia gyvenimo kokybę ir išgyvenamumą. Populiacijai senstant, 2040 metais žmonių, sergančių PAOL, skaičius padidės iki 22 proc.. Taigi, akivaizdžiai galime pastebėti, kad žmonėms senstant, daugėja PAOL sergančiųjų ir ši liga progresuoja, blogina žmonių gyvenimo kokybę bei didina mirštamumą ar sunkina gretutinių susirgimų eigą. Ilgėjant žmonių amžiui, jie turi daug gretutinių susirgimų. Todėl PAOL operacinis gydymas gali būti gyvybei pavojingas, nes sukelia gretutinių ligų pasunkėjimą. Šiuo metu šią problemą bandoma spręsti pritaikant endovaskulinius arterijų užakimo koregavimo metodus, kurie yra mažai invazyvūs, atliekami vietinėje nejautroje ir sąlyginai pigūs. Darbo tikslas: palyginti subintiminės angioplastikos (SA), arterijų šuntavimo operacijų ir perkutaninės transliuminalinės angioplastikos (PTA) gydymo rezultatus, esant paviršinės šlaunies arterijos lėtiniam užakimui bei įvertinti subintiminės angioplastikos rizikos veiksnius. Darbo uždaviniai: 1. Įvertinti subintiminės ir perkutaninės transliuminalinės angioplastikų bei arterijų šuntavimo operacijos ypatumus, gydant lėtinį paviršinės šlaunies arterijos užakimą. 2. Įvertinti... [toliau žr. visą tekstą] / The Aim The aim of this study is to compare the results of subintimal angioplasty (SA), the bypass surgery and percutaneus transluminal angioplasty (PTA) in treatment of the chronic occlusion of superficial femoral artery (SFA) and determine risk factors of subintimal angioplasty. The objectives: 1. To evaluate peculiarity of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 2. To evaluate the primary results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 3. To evaluate the early results of subintimal and percutaneus transluminal angioplasty and arterial bypass surgery in treatment the chronic occlusion of superficial femoral artery. 4. To determine risk factors predicting the primary and the early results of chronic superficial femoral artery occlusion treatment by means of subintimal and percutaneus transluminal angioplasty and the arterial bypass surgery. 2.1. Patients The prospective clinical study is being performed at the Department of Vascular Surgery of the Clinic of Cardiac, Thoracic and Vascular Surgery of Kaunas University of Medicine. The study was started in November 2002 and ended on December 2006. We had 255 patients admitted to the clinic during this period of time due to the occlusion of SFA, which matched the criteria of the study. The patients were... [to full text]

Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2004.

Darbo tikslas - Įvertinti su amžiumi susijusius struktūrinius žmogaus pamatinės arterijos sienelės pokyčius. Darbo uždaviniai: 1. Ištirti pamatinės arterijos medijos kolageninių skaidulų kiekybinius pokyčius; 2. Nustatyti pamatinės arterijos sienelės medijos raumeninių ląstelių kiekybinius pokyčius; 3. Ištirti pamatinės arterijos sienelės medijoje esančių elastinių skaidulų kiekybinius pokyčius; 4. Ištirti pamatinės arterijos sienelės medijos storio pokyčius; 5. Nustatyti žmogaus pamatinės arterijos intimos, vidinės elastinės membranos struktūrinius pokyčius; 6. Įvertinti kiekybinių histologinių pokyčių tarpusavio priklausomybę bei sąsają su amžiumi. Mokslinis naujumas Galvos smegenų kraujotakos sutrikimai yra viena iš priežasčių, lemiančių didžiausią mirtingumą ir neįgalumą. Epidemiologiniai tyrimai rodo, kad sergamumas ir mirtingumas dėl galvos smegenų kraujotakos sutrikimų tarp vyresnio amžiaus asmenų turi tendenciją sparčiai didėti. Šiame darbe žmogaus galvos smegenų pamatinės arterijos sienelės struktūros pokyčiai vertinti amžiniu aspektu. Histomorfometriškai analizuota medžiaga leido įvertinti bendruosius pamatinės smegenų arterijos sienelės ypatumus, susijusius su amžiumi. Histomorfometriškai įvertinome pamatinės arterijos medijos elastinių ir kolageninių skaidulų bei raumeninių ląstelių kiekybinius pokyčius susijusius su amžiumi skirtingose amžiaus grupėse. Tyrimo metu nagrinėjome ne tik elastinių skaidulų ir kolageno tinklo plotą, bet apskaičiavome ir skaidulų... [toliau žr. visą tekstą] / The aim of the investigation was to examine and evaluate age-related structural changes in media of human basilar artery The main objectives of the thesis were as follows: 1. To examine the quantitative changes in the collagen fibres in media of basilar artery; 2. To evaluate the quantitative changes in muscular cells in the media of basilar artery; 3. To evaluate the quantitative changes in the elastic fibres in the media of basilar artery; 4. To evaluate the changes in the thickness of the tunica media; 5. To examine the structural changes in the human basilar artery intima and internal elastic membrane; 6. To assess the relation of different quantitative histological changes and to determine their correlation with age. Academic novelity of the investigation Cerebrovascular diseases cause huge mortality and disablement. Epidemiologic research has revealed that the morbidity and mortality rates due to cerebrovascular diseases tend to increase. We evaluated basilar artery wall structural changes occuring while ageing. Histomorphometrically analysed material enabled to evaluate general cerebral artery wall peculiarities related to age. We evaluated histomorphometrically quantitative changes of elastic and collagen fibres, muscular cells in ageing in different age groups. We also made analysis not only of elastic and collagen fibres area, but also of perimeter and number of fibres. We analyzed the changes in the thickness of the tunica media. We examined the structural... [to full text]

Širdies ir kraujagyslių sistemos ligos sudaro didžiąją dalį tarp sergamumo, mirtingumo ir neįgalumo priežasčių. Mirtingumo rodiklių vertinimas - tradicinis pirminis išeičių matavimas, tačiau ir pacientai, ir medikai vis labiau domisi ne vien tuo, kaip sumažinti mirtingumą, bet ir kaip sumažinti simptomus, padidinti funkcines galimybes, kitaip tariant, pagerinti su sveikata susijusią gyvenimo kokybę. Darbo tikslas – išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę bei jos pokyčius ilgalaikio stebėjimo metu. Uždaviniai: 1. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo sociodemografinių rodiklių (amžiaus, lyties, išsilavinimo, darbinės padėties). 2. Išnagrinėti sergančiųjų IŠL su sveikata susijusią gyvenimo kokybę priklausomai nuo pradinės funkcinės būklės (kardiovaskulinės, psichoemocinės, miego kokybės). 3. Įvertinti kardiovaskulinės, psichoemocinės būklės bei miego kokybės įtaką sergančiųjų IŠL su sveikata susijusiai gyvenimo kokybei. 4. Įvertinti sergančiųjų IŠL (po ūminio miokardo infarkto, perkutaninės transliuminalinės vainikinių arterijų angioplastikos ir aorto-vainikinių arterijų jungčių operacijos) su sveikata susijusios gyvenimo kokybės pokyčius ilgalaikio stebėjimo metu. Tyrimo kontingentas ir metodai. Tiriamąjį kontingentą sudarė KMU Psichofiziologijos ir reabilitacijos instituto kardiovaskulinės reabilitacijos klinikos pacientai, atvykę reabilitaciniam gydymui po ūmaus miokardo infarkto, perkutaninės... [toliau žr. visą tekstą] / Cardiovascular diseases including coronary artery disease (CAD) are very prevalent in Lithuania. The primary outcome interest has traditionally been mortality, but patients and researchers are increasingly interest in identifying interventions that not only improve mortality, but also reduce symptoms, increase functional ability; in other words, improve patients health-related quality of life. Health-related quality of life represents the effect of an illness and its treatment as perceived by the patient, that it is modified by impairments, functional stress, perceptions and social opportunities, and is influenced by disease, injury, treatment or policy. The aim of the study was to analyze health-related quality of life in CAD patients and to assess its changes during long-term period. The objectives of the study: 1. To evaluate health-related quality of life in CAD patients according to sociodemographic factors (gander, age, education level and employment status). 2. To evaluate health-related quality of life in CAD patients according to functional status ���� angina pectoris, heart failure, NYHA functional class, anxiety, depression and sleep quality. 3. To assess the impact of demographic factors, cardiovascular status, psycho-emotional status and sleep quality on health-related quality of life in CAD patients. 4. To assess the health-related quality of life changes during long-term period in CAD patients (after acute myocardial infarction (MI), percutaneous transluminal... [to full text]

Advances in coronary Computed Tomography Angiography (CTA) have resulted in a boost in the use of this new technique in recent years, creating a challenge for radiologists due to the increasing number of exams and the large amount of data for each patient. The main goal of this study was to develop a computer tool to facilitate coronary CTA analysis by combining knowledge of medicine and image processing, and to evaluate the performance in clinical settings. Firstly, a competing fuzzy connectedness tree algorithm was developed to segment the coronary arteries and extract centerlines for each branch. The new algorithm, which is an extension of the “virtual contrast injection” (VC) method, preserves the low-density soft tissue around the artery, and thus reduces the possibility of introducing false positive stenoses during segmentation. Visually reasonable results were obtained in clinical cases. Secondly, this algorithm was implemented in open source software in which multiple visualization techniques were integrated into an intuitive user interface to facilitate user interaction and provide good over­views of the processing results. An automatic seeding method was introduced into the interactive segmentation workflow to eliminate the requirement of user initialization during post-processing. In 42 clinical cases, all main arteries and more than 85% of visible branches were identified, and testing the centerline extraction in a reference database gave results in good agreement with the gold standard. Thirdly, the diagnostic accuracy of coronary CTA using the segmented 3D data from the VC method was evaluated on 30 clinical coronary CTA datasets and compared with the conventional reading method and a different 3D reading method, region growing (RG), from a commercial software. As a reference method, catheter angiography was used. The percentage of evaluable arteries, accuracy and negative predictive value (NPV) for detecting stenosis were, respectively, 86%, 74% and 93% for the conventional method, 83%, 71% and 92% for VC, and 64%, 56% and 93% for RG. Accuracy was significantly lower for the RG method than for the other two methods (p&lt;0.01), whereas there was no significant difference in accuracy between the VC method and the conventional method (p = 0.22). Furthermore, we developed a fast, level set-based algorithm for vessel segmentation, which is 10-20 times faster than the conventional methods without losing segmentation accuracy. It enables quantitative stenosis analysis at interactive speed. In conclusion, the presented software provides fast and automatic coron­ary artery segmentation and visualization. The NPV of using only segmented 3D data is as good as using conventional 2D viewing techniques, which suggests a potential of using them as an initial step, with access to 2D reviewing techniques for suspected lesions and cases with heavy calcification. Combining the 3D visualization of segmentation data with the clinical workflow could shorten reading time.

Coronary arteries stenosis causes ischemic heart disease which is the main fatality reason all over the world. For diagnosis arteries stenosis invasive and noninvasive methods are used. These methods are quite expensive and not all medical institutions can carry out such tests. Analysis of electrocardiogram could be one of the cheapest and current methods to diagnose arteries stenosis. Despite the fact, that in some cases such analysis is not very informative, medics look for the informative ECG parameters and their combinations in order to predict stenosis. The goal of this work is to create statistical methods and software for prognosis of coronary arteries stenosis using digital ECG parameters. Data was colecet and prepared for this reseach in Clinic of Cardiology of Kaunas Medical University. In this work are presented: 1.Statistical analysis models for prognosis of coronary arteries stenosis. 2.Software for uses. 3.Comparative analysis of statistical analysis models. 4.Results of real data analysis, which were obtained by using, developed statistical models and software. Obtained results will be used to improve methods of diagnosis ischemic heart disease and arteries stenosis in Clinic of Cardiology of Kaunas Medical University.